Endoscopic ultrasound core needle for diagnosing of solid pancreatic lesions: is rapid on-site evaluation really necessary?

Arena, Monica; Eusebi, Leonardo Henry; Pellicano, Rinaldo; Palamara, Maria A; Iabichino, Giuseppe; Consolo, Pierluigi; Fagoonee, Sharmila; Opocher, Enrico; Barabino, Matteo; Luigiano, Carmelo

doi:10.23736/s0026-4806.17.05327-7

Cited by 23 publications

(5 citation statements)

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“…It has been recently debated that, although there is not a clear diagnostic advantage of FNB over FNA, the use of larger needles brings secondary benefits, such as decrease in the number of passes and a smaller need for ROSE 10,41,42 —which might be particularly advantageous in services that do not have an available cytopathologist on‐site. Studies have also pointed out that ROSE can even negatively affect procedure by increasing its length 43 .…”

Section: Discussionmentioning

confidence: 99%

“…22,38,39 It is important to note that this referred study was evaluating cystic lesions, leading to greater intracystic haemorrhage when using FNB and, therefore, higher adverse events rate. 31,40 It has been recently debated that, although there is not a clear diagnostic advantage of FNB over FNA, the use of larger needles brings secondary benefits, such as decrease in the number of passes and a smaller need for ROSE 10,41,42 TA B L E 3 FNA and FNB selected variables results, with comparison between groups, reaching high heterogeneity (I 2 ) and no significant statistical difference with a random effect model.…”

Section: Samplementioning

confidence: 99%

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Small biopsies for pancreatic lesions: Is there still room for fine needle aspiration?

Bueno,

Felipe‐Silva,

Saieg

2023

Cytopathology

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Pancreatic carcinoma is an aggressive tumour with increasing incidence in both sexes worldwide. Early detection is, therefore, essential for patient management. A recent advancement involves the utilization of larger, thicker gauge needles, which enable the collection of core‐type biopsies (FNB). Here, we investigated the role of fine needle aspiration and cytopathology in the diagnostic workflow of pancreatic lesions. A search query was designed to search for articles in the PubMed database comparing FNA and FNB for biopsy of pancreatic lesions, and detailed data were extracted from selected studies. Statistical analyses were performed using the R package meta version 6.2. Twenty‐one studies made the final cut for data extraction. Overall, median age was 64.3 years (±6.1; 47.6–71.5), male: female proportion 53.9 (±11.3; 27.6–67.4), lesion size 3.1 cm (±0.5; 1.9–4.2 cm) and percentage of malignant cases 78.3% (±26.8; 2.1–100). FNA and FNB diagnostic yield was 85.8% (±10.3; 70.0–100.0) and 89.2% (±7.7; 70.0–98.6), respectively. Average accuracy was 89.5% (±11.7; 63.0–100.0) for FNA and 90.8% (±7.1; 77.0–100.0) for FNB. Adverse effects rate was 1.0% (±1.3; 0–4.3) for FNA and 2.2% (±4.4; 0–16.1) for FNB. None of the selected variables had a significant statistical difference between both methods. FNA and FNB perform similarly for diagnostic material acquisition in pancreatic lesions. The best outcome comes from the association of both techniques, emphasizing the value of combining cytological and histological morphology for the most accurate analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Samplementioning

confidence: 99%

Small biopsies for pancreatic lesions: Is there still room for fine needle aspiration?

Bueno,

Felipe‐Silva,

Saieg

2023

Cytopathology

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“…[25] In line, Arena et al found no additional benefit of an on-site cytopathologist in terms of accuracy when FNB is compared to FNB with ROSE. [26]…”

Section: Discussionmentioning

confidence: 99%

“…[25] In line, Arena et al found no additional benefit of an on-site cytopathologist in terms of accuracy when FNB is compared to FNB with ROSE. [26] While FNB needles enable the acquisition of larger specimens on which to perform immunohistochemical and molecular analyses, [6] LBC likewise allows to perform these advanced staining protocols for a detailed characterization of cytospin pellets. [8] Our study has several strengths and limitations.…”

Section: Discussionmentioning

confidence: 99%

Increased accuracy of FNA-based cytological diagnosis of pancreatic lesions by use of an ethanol-based fixative system: A STROBE compliant study

et al. 2022

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EUS-guided fine needle aspiration cytology (FNA) is the gold standard of evaluation of solid pancreatic lesions. However, accuracy is generally low. The aim of this study was to compare the diagnostic yield of conventional cytology (CC) with liquid-based cytological analysis using an ethanol based fixative system (LBC) without onsite cytopathological assessment. We performed a retrospective evaluation in patients referred to the Department of Interdisciplinary Endoscopy at Jena University Hospital for FNA of pancreatic masses between 2008 and 2015. LBC preservation of specimen was introduced in April 2011. Gold standard was defined as a surgically obtained histology or a patient follow-up of at least 1 year for diagnosis or exclusion of malignancy. 172 patients were included into the final analysis. Mean age was 64.8 years (SD 12.4 years), 105 patients were male. 107 lesions were malignant, while 65 lesions were benign. 89 specimens were evaluated by CC, whereas 83 specimens were processed by LBC. Liquid-based cytology performed significantly better than conventional cytology in terms of sensitivity (87.8% vs 67.2% (P = .021)), specificity (100% vs 87.1% (P = .047)) negative predictive value (NPV) (85% vs 58.7% (P = .009)) and accuracy (92.8% vs 74.2% (P = .001)). We observed no learning curve after implementation of LBC Liquid based cytology is a simple and inexpensive technique that helps improving sensitivity, specificity, NPV and accuracy over conventional cytology in fine needle aspirates from patients with pancreatic lesions. Therefore, this real-world evidence shows, that EUS-FNA specimen processing should be performed using LBC to achieve best possible results.

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“…Despite its established reliability and safety [ 6 ], EUS-TA’s diagnostic accuracy depends on factors like sampling methods, needle types, endosonographer expertise, and the availability of rapid on-site evaluation (ROSE) [ 3 ]. Integrating ROSE into EUS-TA can enhance sampling efficiency and success rates by ensuring sample adequacy, potentially boosting diagnostic accuracy by 10–15% [ 7 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

A Rapid On-Line Evaluation (ROLE) Protocol in the Diagnostic Performance Improvement in Endoscopic Ultrasound-Guided Tissue Acquisition for Solid Pancreatic Lesions

Cai,

Rao,

Zhang

et al. 2024

Diagnostics

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We assessed the rapid on-line evaluation (ROLE) protocol as a modification to the conventional rapid on-site evaluation (ROSE) in the diagnostic performance improvement in endoscopic ultrasound-guided tissue acquisition (EUS-TA) for solid pancreatic lesions. This single-center, retrospective study involved consecutive patients with solid pancreatic lesions undergoing EUS-TA at Peking University First Hospital between October 2017 and March 2021. Among 137 patients enrolled, 75 were in the ROLE group and 62 were in the non-ROSE group. The diagnostic yield (97.3% vs. 85.5%, p = 0.023), accuracy (94.7% vs. 82.3%, p = 0.027), and sensitivity (95.7% vs. 81.1%, p = 0.011) were significantly higher in the ROLE group compared to the non-ROSE group. However, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) showed no significant differences (all p-values > 0.05). Additionally, there was a noteworthy reduction in the number of needle passes required in the ROLE group compared to the non-ROSE group (two vs. three, p < 0.001). In a subgroup analysis, fine needle biopsy (FNB) combined with ROLE demonstrated superior diagnostic accuracy compared to FNB with non-ROSE (100% vs. 93.1%, p = 0.025). Compared with the non-ROSE protocol, the ROLE protocol might improve the diagnostic performance of EUS-TA for solid pancreatic lesions, and potentially reduce the number of needle passes requirement.

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Endoscopic ultrasound core needle for diagnosing of solid pancreatic lesions: is rapid on-site evaluation really necessary?

Cited by 23 publications

References 0 publications

Small biopsies for pancreatic lesions: Is there still room for fine needle aspiration?

Small biopsies for pancreatic lesions: Is there still room for fine needle aspiration?

Increased accuracy of FNA-based cytological diagnosis of pancreatic lesions by use of an ethanol-based fixative system: A STROBE compliant study

A Rapid On-Line Evaluation (ROLE) Protocol in the Diagnostic Performance Improvement in Endoscopic Ultrasound-Guided Tissue Acquisition for Solid Pancreatic Lesions

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